Organization
THE CAROLYN E. WYLIE CENTER
Active
Other names
The Wylie Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICKEY RUBINSON (C.E.O.)
(951) 683-5193
Entity
Organization
Contact information
Practice address
4164 BROCKTON AVE, RIVERSIDE, CA 92501-3400
(951) 683-5193
(951) 683-6019
Mailing address
4164 BROCKTON AVE, RIVERSIDE, CA 92501-3400
(951) 683-5193
(951) 683-6019
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
33BA00
OTHER
CA
01
—
33BAA0
OTHER
CA
Enumeration date
03/16/2007
Last updated
08/11/2021
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